Antimicrobials: Thienomycins aka "Penems"

Question 1

Thienamycins (“Penems”)

Answer 1

Broadest class of antibiotics

Question 2

4 drugs of the penems

Answer 2

imipenem/cilastatin
ertapenem
meropenem
doripenem

Question 3

MoA of penems

Answer 3

similar to PCNs/cephs, cell wall active

Question 4

Penem cross allergy with PCN

Answer 4

5 - 10 %

Question 5

common side effect of IV infusion: penems

Answer 5

nausea/vomiting

Question 6

Benefit of penems

Answer 6

post antibiotic effect (PAE)

Question 7

Thienamycins / “Penems” active against

Answer 7

most GP/GN aerobes EXCEPT MRSA and E. faecium

Question 8

which aerobes are penems not active against

Answer 8

MRSA

E faecium

Question 9

Penems in gram neg anaerobes

Answer 9

active against them, including B fragilis.

Question 10

Meropenem

Answer 10

has the best activity against psuedomonas

Question 11

ertapenem

Answer 11

has no psuedomonas activity but great against ESBLs.

Question 12

ESBL

Answer 12

extended spectrum beta lactamases

Question 13

FYI for imipenem/cilastatin

Answer 13

lowers seizure threshold in pts with CNS disease or decreased renal function.

Question 14

Imipenem is always given with Cilastatin, why?

Answer 14

to prevent nephrotoxicity from imipenem by breaking down its toxic metabolites.

Question 15

Penem for ESBLs

Answer 15

ertapenem

Question 16

Penem for psuedomonas

Answer 16

meropenem

Question 17

Distribution of thienamycins / “Penems”

Answer 17

widely distributed to body compartments, meninges, bile, bone, synovial fluid, most tissues.

Question 18

dose reduce penems for

Answer 18

renal insufficiency

Question 19

why check renal function before imipenem/cilastatin if cilastatin blocks nephrotoxicity?

Answer 19

if renal function is compromised, imipenem still may accumulate, lowering the seizure threshold.

Question 20

what effect may you see with the ‘penems?

Answer 20

post antibiotic effect

Question 21

drug of choice for ESBLs

Answer 21

‘penem